Accuracy of Rapid Emergency Medicine Score and Sequential Organ Failure Assessment Score in predicting acute paraphenylenediamine poisoning adverse outcomes.

Paraphenylenediamine (PPD) is a commonly used xenobiotic in hair dying, causing deleterious outcomes in acute poisoning. Although many epidemiological studies and case reports explained their clinical presentations and fatal consequences, no studies have evaluated the early determinants of adverse outcomes. Therefore, the present study aimed to assess the initial predictors of acute PPD poisoning adverse outcomes, focusing on the discriminatory accuracy of the Rapid Emergency Medicine Score (REMS) and Sequential Organ Failure Assessment (SOFA) score. A retrospective cohort study included all acute PPD-poisoned patients admitted to three Egyptian emergency hospitals from January 2020 to January 2022. Data was gathered on admission, including demographics, toxicological, clinical, scoring systems, and laboratory investigations. Patients were categorized according to their outcomes (mortality and complications). Ninety-seven patients with acute PPD poisoning were included, with a median age of 23 years, female predominance (60.8%), and suicidal intention (95.9%). Out of all patients, 25.77% died, and 43.29% had complicated outcomes. Respiratory failure was the primary cause of fatalities (10.30%), while acute renal failure (38.14%) was a chief cause of complications. The delay time till hospitalization, abnormal electrocardiogram, initial creatine phosphokinase, bicarbonate level, REMS, and SOFA scores were the significant determinants for adverse outcomes. The REMS exhibited the highest odds ratio (OR = 1.91 [95% confidence interval (CI): 1.41-2.60], p < 0.001) and had the best discriminatory power with the area under the curve (AUC) = 0.918 and overall accuracy of 91.8% in predicting mortality. However, the SOFA score had the highest odds ratio (OR = 4.97 [95% CI: 1.16-21.21], p = 0.001) and only yielded a significant prediction for complicated sequels with AUC = 0.913 and overall accuracy of 84.7%. The REMS is a simple clinical score that accurately predicts mortality, whereas the SOFA score is more practicable for anticipating complications in acute PPD-poisoned patients.

Can Hematological Ratios Predict Outcome of COVID-19 Patients? A Multicentric Study.

INTRODUCTION: Coronaviruses belong to a large family that leads to respiratory infection of various severity. Hematological ratios are indicators of inflammatory response widely used in viral pneumonia with affordability in developing countries. PURPOSE: Study the role of the neutrophil lymphocyte ratio (NLR), derived NLR ratio (d-NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) in predicting the outcome of COVID-19 Egyptian patients. METHODS: A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers, grouped into non-severe, severe, and critical. Patients' laboratory assessment including total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, d-NLR, LMR and, PLR were reported as well as C reactive protein (CRP), D-dimer and serum ferritin. RESULTS: TLC, ANC, AMC, NLR, d-NLR and, PLR were highest in the critical group (p<0.001 for all except AMC p=0.033), while this group had the least ALC and LMR (p=0.049 and <0.001, respectively). Higher CRP and d-dimer levels were reported in the critical group (p<0.001). At the same time, higher ferritin was found in the severe group more than the critical and non-severe groups (p<0.001, p=0.005, respectively). We calculated the optimal cut-off values of the hematological ratio; NLR (3.5), d-NLR (2.86), PLR (192), and LMR (3). D-NLR had the highest specificity (89.19%), while NLR had the highest sensitivity (71.38%). By univariate logistic regression, age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PLR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with the severity of COVID-19. Still, only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. CONCLUSION: NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PLR may assist in risk stratification.